Letter to the Editor  |   November 2014
Chewing Gum: A Hazard That Warrants Delaying the Case?
Author Affiliations
  • Andrew S. Greenwald, B.A.
    Newark, New Jersey
  • Yuriy A. Gubenko, M.D.
    Newark, New Jersey
Article Information
Letter to the Editor
Letter to the Editor   |   November 2014
Chewing Gum: A Hazard That Warrants Delaying the Case?
ASA Monitor 11 2014, Vol.78, 57.
ASA Monitor 11 2014, Vol.78, 57.
Rigorous, peer-reviewed guidelines exist from ASA toward the preoperative fasting period.1  While these guidelines are exhaustive, they fail to directly address chewing gum, an issue of controversy within the literature.
The effect of chewing gum toward raising intragastric volume has been proven in several small trials. A randomized trial of 21 patients found a statistically significant increase in intragastric volume, but the same trial did not find a significant difference in gastric pH.2  Similar results were found in a study looking for prevention of preoperative mouth dryness – and chewing gum failed to provide a suitable intervention.3  Nicotine chewing gum was assessed, to no avail, in a randomized clinical trial to ease the perioperative fasting period in smokers.4  The same results may be exaggerated by coexisting disease. A morbidly obese man undergoing obesity surgery admitted to chewing gum two hours prior to surgery and reported throwing out the gum. Upon direct laryngoscopy, the patient regurgitated 90 ml of saliva, complicating intubation efforts.5 
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